Are you a Broker? If you are human, leave this field blank. Are you a broker? * Yes NoOkay. Please contact us using our (Client Help) forms. I need help with * registering to bind policies Coverages making changes to an existing policy adding an Additional Insured to an existing policy commission rates something else Okay. Which Specialty Insurance product are you interested in? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance I'm not sure Great choice. Did you know you can register online and bind policies instantly?Would you like to register online or have us call you? * Register Online Call MeOkay. No problem. We just need a few more details. What is your name? * What is your company name? * What is your telephone number? * Extension? (This is optional) What is your email address? * How can we help you? Okay. We just need a few more details. What is your name? * What is your company name? * What is your telephone number? * Extension? (This is optional) What is your email address? * Anything you'd like to add? Okay. Which Specialty Insurance product are you interested in? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance I'm not sure Great, would you like to take a look at our FAQ section or would you like us to call you? * See FAQs Now Call MePerfect. We just need a few more details. What is your name? * What is your company name? * What is your telephone number? * Extension? (This is optional) What is your email address? * How can we help you? Okay. Which specialty insurance policy? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Great choice! We just need a few more details to assist you. What is the name of the person on the policy? * What is your name? * What is your company name? * What is your telephone number? * What's the best time to call? * Mornings Afternoons What is your email address? * What is your Client's ID, Policy or Memorandum number? * What changes would you like to request on your Client's policy? * Okay. Which specialty insurance policy? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Great Choice.Did you know you can add an Additional Insured and get an instant Certificate of Insurance using our online policy management system? Would you like to use this form anyway or sign in? * Use this form Sign in and Manage Your PolicyOkay. Request for certificates using this form are processed during business hours on a first come, first served basis. What is the name of the person on the policy? * What is your name? * What is your telephone number? * What is your email address? * If we need to contact you, which is better? * Call Me Email is better Whatever you needOkay, if we have questions we'll contact you by email. What is the best time to call? * Mornings Afternoons Hidden Flag - Show more js We just need a few more details. What is your Client's ID, Policy or Memorandum number? * Hidden Flag - Detect mobile js Hidden Flag for Extra Time Fields Hidden Flag for Extra Services Provided DJ What day does your event start? * What time does your event start? * Event Start Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What day does your event end? * What time does your event end? * Event End Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What day and time does your event start? Start Date (Desktop) * Start Time (Desktop) * Event Start Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What day and time does your event end? Stop Date (Desktop) * Stop Time (Desktop) * Event Stop Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What services will you provide for this event? * What type of Additional Insured is this? * What is the name and address of the Additional Insured? * Street * Address 2 City * State * -- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Any Additional Insured wording you’d like to add? This is optional. Would you like a copy of the Certificate sent to another email address, such as to your Client or your Client's Additional Insured? What is the email address to send a copy? No problem. Which specialty insurance product are you interested in? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Great choice. Hidden Flag - Show more js Would you like one of our insurance experts to call you? Yes NoWhat’s the best time to call? Mornings AfternoonsPerfect. We just need a few more details.No problem. We'll email you. What is your name? What is your phone number? * What is your email address? * What is your email address? (Optional) * How can we help? Submit